hEALTH SCREENING registration

Note: Making an appointment, simply fill in the following form and our staff will contact you to confirm your appointment with us.
Appointment date requested should be at least 3 working days from the day you submit the form.
Appointment dates are subjected to availability.

To change or cancel your appointment, please kindly call our Customer Service Representatives at (65) 6763 5277 or SMS us at (65) 9145 6208.

Fields with * are mandatory.

Personal Information
Name (as in NRIC/Passport) *	:
NRIC/FIN/PP No. *	:
Email Address *	:
Date Of Birth *	:
Gender *	:	Female Male
Race *	:	Chinese Malay Indian Others
Nationality *	:	Singaporean PR Malaysian China India Indonesian Others
Address	:
Zip Code	:
Phone Number	:
Mobile Number *	:

Health Screening Package Information
Health Screening Packages	:
Screening Date	:
Screening Ares	:
Screening Time	:	8:30am 8:45am 9:00am 9:15am 9:30am 9:45am 10:00am
Add-on Tests (Optional) *	:
Promotional Code	:	No Yes
Remarks	:
* Cash payment only